The National Paediatric Diabetes Audit
The National Paediatric Diabetes Audit (NPDA) 2014/15 was published on 31st May 2016 by the Royal College of Paediatrics and Child Health (RCPCH). The NPDA showed continued improvement in HbA1c levels in children with diabetes in England & Wales and this is an extremely positive development which should be widely welcomed. It no doubt reflects the improvements in modern insulins, administration devices (including pumps) and means of monitoring blood glucose levels. More importantly, however, there has been an increasing financial allocation to paediatric diabetes which has led to additional staff, especially diabetes nurse specialists and dietitians who allow these new tools to be appropriately deployed.
And yet the headlines highlight that ‘concerns over recording of vital healthcare checks remain’ effectively putting a damper on what should be seen as very good news. Is it appropriate to put equivalent weight on the other six recommended health care checks – I think not. Take the example of serum cholesterol; hardly any clinicians in the UK would consider the use of statins in people aged under 18 years and since the effect of diet is minimal on this marker (and no different to the recommendations already given to children with type 1 diabetes), what is the point of screening for it? One could make a similar argument for checking the urine albumin : creatinine ratio in children of less than 5 years diabetes duration unless there is a plan to use ACE-inhibitors in the miniscule number who test positive. Even retinopathy screening within five years of diagnosis will yield negligible numbers of positive findings and probably causes more anxiety than benefit.
The adoption of the seven healthcare checks for children with type 1 diabetes smacks of copying the rather simplistic way of managing type 2 diabetes in adults. Paediatricians have much longer consultations with their patients and families than is the case in adult clinics – I’m sure that they can use this time more productively than being shamed into testing for things that won’t be there.
Professor Steve Bain